Texas Telemedicine Laws: Licensure, Prescribing, Parity

Texas is a full-license state that made itself easier to enter through the Interstate Medical Licensure Compact rather than through a telehealth registration. It writes its core telemedicine rules into statute, holds remote care to the same standard as an office visit, and has coverage parity without payment parity. The prescribing rule that catches multi-state groups: chronic pain with scheduled drugs generally requires two-way video.

Licensure: full license, compact on-ramp

Under Occupations Code § 151.056, a person physically located outside Texas who performs an act that is part of a patient care service initiated in Texas by electronic means is engaged in the practice of medicine in Texas. The Medical Board's telemedicine rule, 22 TAC § 175.1, then closes the door that used to be open: a physician may not provide telemedicine medical services to patients in Texas without a full Texas medical license, except for physicians who already held an out-of-state telemedicine license as of September 1, 2022. That license is now a grandfathered category, not a pathway.

The statutory exceptions are narrow: episodic consultation by an out-of-state specialist with a Texas-licensed physician in the same specialty, consultation with Texas medical schools and certain UT institutions, and bordering-state physicians ordering home health or hospice services. None covers an ongoing telehealth relationship with a Texas patient.

What Texas offers instead is the Interstate Medical Licensure Compact. Texas enacted membership through HB 1616 and began participating in 2022, and the Board confirms Texas can serve as a physician's state of principal license. Texas also participates in the Physical Therapy Compact. For the nursing, psychology, and counseling compacts, confirm current Texas status directly with each compact commission before relying on it.

One structural point: Occupations Code § 111.008 says Chapter 111 "does not apply to mental health services." That removes the statute's relationship-formation and consent provisions from mental health care, not licensure, Board rules, or the standard of care — telepsychiatry practices should read it as a narrowing, not an exemption.

Prescribing: the relationship can start online; pain has its own rule

Occupations Code § 111.005 lets a practitioner-patient relationship form by telemedicine when the practitioner meets the standard of care and uses synchronous audiovisual interaction, asynchronous store-and-forward technology paired with clinically relevant images or records, or another form of audiovisual technology that allows compliance with the standard of care. No prior in-person exam is required. A relationship formed that way generally carries follow-up duties, including a report to the patient's primary care physician within 72 hours, subject to the statute's conditions. Whether audio-only alone can open a new relationship is a question for the Board; the statute's list is audiovisual.

Section 111.007 holds telemedicine to the same standard of care as an in-person visit and bars any agency from imposing a higher one by rule.

22 TAC § 175.3 requires an established relationship and compliance with all other applicable law, including the Texas Controlled Substances Act, before any dangerous drug or controlled substance is prescribed. Texas bans no schedule outright by telehealth, so the federal DEA framework does most of the work; verify current status in our DEA prescribing report. The Texas-specific limit is chronic pain: treating chronic pain with scheduled drugs by telemedicine requires two-way audio-video unless the patient is an established pain patient of the prescribing physician, receives a prescription identical to the previous visit, and was seen in person or by audio-video within the last 90 days. Two other lines are statutory: § 111.005 states that no practitioner-patient relationship exists when a practitioner prescribes an abortifacient, and § 111.009 caps teledentistry controlled-substance prescriptions at two days for opiates and five days otherwise.

Consent: required by statute, formats being standardized

Under Occupations Code § 111.002, the treating physician or health professional who provides or facilitates telemedicine or telehealth must ensure informed consent is obtained from the patient, or from an authorized decision-maker, before services are provided. The Board's rule adds that complaint-notice postings must follow Chapter 111 and the Medical Practice Act.

HB 1700, effective September 1, 2025, amended § 111.004 to require every agency regulating telehealth professionals to adopt rules standardizing the format and retention of consent records for treatment, data collection, and data sharing, including provisions for consent documented in an audio-only format. Boards are implementing it one at a time — the Board of Nursing's rule took effect April 9, 2026 and allows written or documented verbal consent. Verify with the Medical Board whether the physician rule is final before locking intake forms.

Medicaid: broad modalities, home included, no facility fee at home

Texas Medicaid, run by HHSC and administered through TMHP, covers telemedicine (physician-delivered), telehealth (other licensed professionals), and home telemonitoring. Live video is billed with modifier 95; audio-only carries modifier 93 for non-behavioral services and FQ for behavioral health. Audio-only is limited to services HHSC has designated as clinically effective and cost-effective in the benefit language, and behavioral health audio-only requires informed consent before the service. The handbook treats store-and-forward mainly as a companion to audio-only encounters rather than a standalone benefit.

The patient's home is a permitted site, but the Q3014 facility fee is not payable when the home is the patient site. Consent may be written or verbal (verbal must be documented), a parent must consent before anyone else joins a child's visit, and school-based visits require advance parental consent. Home telemonitoring covers diabetes or hypertension with a qualifying risk factor and certain medically complex children, with prior authorization in up-to-180-day blocks. Managed care organizations may not deny reimbursement for a covered service solely because it was delivered remotely. Rates come from the fee schedule, not a parity statute.

Private insurance: coverage parity, not payment parity

Insurance Code § 1455.004 requires state-regulated plans to cover a telemedicine or telehealth service "on the same basis and to the same extent" as the same service in person, bars excluding a service solely because it was not delivered in person, caps cost-sharing at the in-person amount, and prohibits a separate telehealth-only deductible or annual maximum. It does not set a payment rate — Texas has no payment-parity mandate — and plans are not required to cover audio-only, text-only, or fax-only services. Section 1455.006 requires issuers to post their telehealth policies and payment practices online, though not negotiated rates — the practical starting point for modeling revenue. HB 1052 added a cross-border rule for plans issued or renewed on or after January 1, 2026: coverage is the same when either party is outside Texas, provided the patient resides primarily in Texas and the provider is Texas-licensed with a Texas office. The broader picture is in our reimbursement guide.

What to watch

Three items: the HB 1700 consent-format rules landing board by board through 2026, the physician rule especially; HB 1052's cross-border coverage rule, which will surface in 2026 plan renewals and contract language; and the federal side, where the DEA's telemedicine prescribing framework and Medicare's telehealth flexibilities change what Texas's permissive rules are worth — verify current status before building on them. The Legislature does not meet in regular session until January 2027, so state changes before then will come from rulemaking. Verify current requirements with the Texas Medical Board and HHSC before acting, and compare Texas with its neighbors in the national overview.